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18D-063 INSURANCE COVERAGE: 4 I have a current liability insurance policy or its equivalent which meets the requirements ofM.G.L. Ch. 112 Yes ® No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy © Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this boxiN, I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ® Master Title ❑ Master - Restricted City /Town ❑Journeyperson Jeffrey E. ault Signature of Licensee Permit # ❑Journeyperson- Restricted License Number: 3810 Fee $ ❑ Check at www.mass.gov /dpl Inspector Signature of Permit Approval - RECEIVED Commonwealth of Massachusetts 12 9 2013 Sheet Metal Permit DEPT •F BUILDING INSPECTIONS 0 13 Permit # -5 19/1 / 3 Estimated Job Cost: $ / 3 D r0 - � 0 IS31 Permit Fee: $ /do- 6 0 Plans Submitted: YES NO Plans Reviewed: YES NO Business License # 128 Applicant License # 3810 Business Information: Property Owner / Job Location Information: Name: Adams Plumbing & Heating, Inc. Name: Premier Supply Group Street: 65 Printworks Dr. (P.O. Box 126) Street: 168 Industrial Park Dr. City /Town: Adams City /Town: Northampton Telephone: 413 743 - 2308 Telephone: 413-584-4250 Photo I.D. required / Copy of Photo I.D. attached: YES X NO Staff Initial J-1/ M -1- unrestricted license J -2 / M -2- restricted to dwellings 3- stories or less and commercial up to 10,000 sq. ft. / 2- stories or less Residential: 1 -2 family Multi- family Condo / Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. X Number of Stories: . 0: 2 " Sheet metal work to be completed: New Work: Renovation: ,V HVAC X Metal Watershed Roofing Kitchen Exhaust System Metal Chimney / Vents Air Balancing Provide detailed description of work to be done: New ductwork to be connected to three (3) new roof tcp units. File # SM- 2013 -0049 APPLICANT /CONTACT PERSON ADAMS PLUMBING & HEATING INC ADDRESS/PHONE P 0 BOX 126 (413) 743 -2308 PROPERTY LOCATION 168 INDUSTRIAL DR MAP 18D PARCEL 063 001 ZONE GI(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out � • • Fee Paid >Y Typeof Construction: DUCTWORK 3 ROOF TOP HVAC UNITS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3810 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN ORMATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER : § Intermediate Project : Site Plan AND /OR Special Permit with Site Plan Major Project: Site Plan AND /OR Special Permit with Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee F/T. • ' from • Str = +mmis on Permit DPW Storm Water Management i 4 ! - Sig re of Buil‘ g Of ial Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact the Office of Planning & Development for more information. 168 INDUSTRIAL DR SM -2013 -0049 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS #: 8963 t SOIC "" ( Map: r �� ° $41 4 ' ' SHEETMETAL PERMIT s L ermit: SHEETMETAL ,s Category: SHEETMETAL Permit # SM- 2013 -0049 Project # JS-2013-001517 PERMISSION IS HEREBY GRANTED TO: Est. Cost: $13,080.00 Contractor: License: Expires: Fee Charged: $100.00 ADAMS PLUMBING & HEATING ISheettnetal - 3810 07/28/2014 (Balance Due: $.00 Owner: KISSELL INC # of Fixtures Applicant: ADAMS PLUMBING & HEATING INC DigSafe # AT: 168 INDUSTRIAL DR U seGroup ConstClass ISSUED ON: 03- Apr -2013 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: DUCTWORK 3 ROOF TOP HVAC UNITS THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Sheetmetal REC- 2013- 005081 29- Mar -13 153188 $100.00 212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :lhasbrouck @northamptonma.gov GeoTMS® 2013 Des Lauriers Municipal Solutions, Inc.